What's Your Target?
There seems to be a lot of discussion these days about “treating to target.” In business jargon, we’d say something about setting goals or how we define success. And basically, that’s what’s happening. Your doctor starts a treatment plan and when certain results are achieved, s/he considers the treatment successful.
I don’t have a problem with this concept. In fact, I like to know that we’re making progress. How do you know you’ve arrived if you don’t know where you’re going? I even like to know if we’re NOT making progress. I just like to know what’s going on and having a defined measurement is a good way to track that.
How does the "treat to target" approach work for RA?
How treatment targets are created
When doctors set treatment targets, they usually base them on lab results or observational findings. For example, there is a DAS28 which is an assessment of how swollen or tender a certain 28 joints are. (DAS stands for Disease Activity Score.) A doctor might want to set a target to improve the DAS28. Another doctor might want to improve overall inflammation levels as shown by lab results.
I personally like data and so I understand my doctor using these targets. However, neither of these (or any of the other clinical scores) have anything to do with how I feel or what I want or need to accomplish. I’ve had rheumatology appointments when my labs were absolutely normal, yet I felt perfectly awful.
What outcomes would you like from treatment?
How do you define success?
I’ve found it helpful to talk to my doctors about what I want out of the treatment plan. Sometimes it’s a specific personal goal. Sometimes it’s about the treatment plan itself. I love to travel, so I need a treatment plan that works well enough that I can do that and which is also convenient enough that I can schedule my travels around it. As another example, I’ve had past issues with fatigue or sleepless nights. None of these things can be measured by joint counts or lab results, but they’re important factors in how I define the success of my treatments.
My husband and I are fortunate that we can take an extended vacation about once a year. There is usually a lot of walking involved in these trips and I have a knee that is particularly troublesome when overused. While there are some things I could do to permanently address the issue, they tend to be along the lines of a nuclear option and are a bit drastic when the knee doesn’t usually bother me on a day-to-day basis.
Get your doctor to help you achieve wanted outcomes
When I do visit my orthopedic surgeon’s office, the first thing he asks is where I’m going. He knows that a strategically placed steroid injection will give me about a month’s reprieve and let me enjoy my vacation. So when I come in to see him, he knows I’m about to leave on vacation. I have set my “treat to target” with this doctor as something that will support my travels and that isn’t too drastic. He is happy to work with me on this along as my exam continues to look good and I don’t overdo the steroids.
Be willing to compromise
There will be compromises. My current RA treatment plan hits nearly every personal target I have. My one complaint is it’s an infusion and I have really bad veins. I hate the infusion but I love the results, so it’s a compromise I’m willing to make. (And after changing treatment plans 10 times in the last 10 years, I’m just happy to find that one that works.) The fact that my doctor is also hitting the targets she’s set for my treatment makes us both happy. (If I could have one that is a bubble bath instead of an infusion, I’d even be happier!)
So talk to your doctor about what your targets are. Maybe it’s less fatigue so you have the energy to play catch with the kids. A successful plan is one that works for both the physician and the patient.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?